As assisters you may have heard from or worked with consumers who were unable to enroll in coverage through the Federally-facilitated Marketplace (FFM) at the end of the current open enrollment period due to certain circumstances they experienced in the process. Certain circumstances across consumer enrollment channels (such as HealthCare.gov and the Marketplace Call Center) leading up to the February 15, 2015 deadline. These circumstances may have kept some consumers from completing the enrollment process despite their efforts to meet the deadline. Consumers may also qualify for a special enrollment period (SEP) to enroll in coverage outside of Open Enrollment under certain circumstances, for example life changes or errors in enrollment.
As a result, CMS will provide a SEP to consumers who meet the following three conditions:
1. Are new enrollees for 2015 coverage who are not currently enrolled in coverage through the FFM
2. Have not been terminated from coverage through the FFM during the 2015 Open Enrollment Period, and
3. Attest that they tried to enroll during the annual Open Enrollment period but did not complete the process (referred to as being “in line”) by February 15, 2015 because they experienced a technical issue with HealthCare.gov that prevented them from completing enrollment by February 15 or an extensive call center wait on February 13, 14 or February 15.
The SEP for “in line” consumers will start on February 16, 2015 and end on February 22, 2015. Enrollments completed during this SEP will have an effective date of March 1, 2015 to align with the effective date eligible consumers would have had if they had been able to complete the enrollment process by the February 15, 2015. Consumers can qualify for this SEP if they meet the criteria above and attest on their Marketplace application that they tried to enroll in coverage during Open Enrollment but did not complete the process by the February 15deadline. Consumers can qualify for this SEP online by visiting HealthCare.gov, or by calling the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325). Once consumers have enrolled in a plan they should contact the insurance company to ask when their first premium is due. Note, that consumers will not be able to access this SEP through the direct enrollment process with issuers. Guidance was also shared with assisters on a marketplace update sent on February 16, 2015.
More info on this SEP is included in this blog in English and in Spanish. Also HealthCare.gov also includes a new alert on the website which includes a blue box which states “Important: If you tried to enroll by 2/15, but couldn’t finish, you may still be able to get 2015 coverage.”